Day after day, countless headlines tell stories about lives tragically cut short by opioids. The problem of prescription drug abuse and overdose is complex and multi-faceted. In addition to the overwhelming number of overdoses, destroyed lives and broken families, there is also a growing financial cost to this widening epidemic.
White House Opioid Task Force
Led by NJ Gov. Chris Christie and Presidential Advisor Jared Kushner, Trump’s opioid task force will be charged with making recommendations for federal funding as part of a three-part plan to combat opioid addiction, which includes enforcement, prevention, and treatment. As part of its budget blueprint, The Better Care Reconciliation Act (BCRA) would appropriate $2 billion in 2018 to fund state grants to boost treatment and recovery services for those struggling with drug addiction and mental health disorders. Those monies will be divided among all 50 states, the District of Columbia, four U.S. territories and the free states of Palau and Micronesia. The grants are expected to supplement funds states have already collected to increase prevention and treatment efforts.
Yet, in an almost contradictory move, the administration has also proposed cuts that would eliminate funding for regional law enforcement task forces as well as the Drug-Free Communities grants, both managed by the White House ‘drug czar’ office (i.e. Office of National Drug Control Policy). The budget blueprint also has a nearly $6 billion budget cut to the National Institutes of Health for 2018 – almost a fifth of its 2017 funding. $2 billion of funding for substance abuse services is like applying a Band-Aid to a gaping wound.
“$2 billion of funding for substance abuse services is like applying a Band-Aid to a gaping wound.”
The Great ACHA Debate
Congress is currently debating the American Health Care Act (AHCA) legislation. If enacted, AHCA would end the enhanced federal matching funds under the Affordable Care Act (ACA) Medicaid expansion. ACA provided extra federal money to New Jersey and other states to expand their Medicaid programs to additional low-income earners. The proposed AHCA bill would phase out the Medicaid expansion beginning in 2021, in addition to capping the amount states can spend on people enrolled in the public health insurance program. Medicaid, the nation’s public health insurance program for low-income children, adults, seniors, and people with disabilities, covers 34 percent of the 2.66 million Americans addicted to opioids, and is the largest funding resource for addiction services across the country.
According to data compiled by the Associated Press, the Affordable Care Act’s Medicaid expansion allowed states to help address the opioid crisis. That expansion accounted for 61 percent of total Medicaid spending on substance abuse treatment in Kentucky, 47 percent in West Virginia, 56 percent in Michigan, 59 percent in Maryland, and 31 percent in Rhode Island. In Ohio, the expansion accounted for 43 percent of Medicaid spending in 2016 on behavioral health, a category that includes mental health and substance abuse.
Considering that the existing Medicaid programs can barely keep up with the treatment demands from our country’s hardest hit states, the ACHA Medicaid cuts will only further endanger addiction treatment. In states such as Idaho, Montana, North Dakota, South Dakota, Nebraska, Arkansas, Louisiana, Mississippi and Tennessee (states significantly affected by the opioid epidemic throughout the Great Plains and Southeast), affordable access and opioid treatment programs are in short supply for the low-income Americans who need it most. In the Southern states of Arkansas, Kentucky, Louisiana, Mississippi and Tennessee (where opioid addiction rates are growing the fastest), the opioid treatment programs that do take Medicaid are only able to accept relatively few patients. In response to substantially reduced federal funding, these states will have to make reductions to their programs, including restrictions in eligibility, benefits, and/or provider payment rates if they cannot replace the lost federal funding from other sources. There is no need to bicker amongst colleagues in Congress. Medicaid is not, and should never be, used as a bargaining tool or funding mechanism for the opioid epidemic.
“Medicaid is not, and should never be, used as a bargaining tool or funding mechanism for the opioid epidemic.”
A Wall of Opportunity
Most Americans agree that our national security, i.e. our borders, must be enforced. President Trump recently proposed the idea of building a “solar wall” on the U.S.-Mexico border. Personally, I love the idea of 2,000 miles of solar panels churning out a constant stream of clean energy. Who wouldn’t? At the end of the day, it’s about money: the cost to build the wall and how to allocate the funds generated from the energy it would produce. Estimated costs are roughly $44.5 billion; with the wall costing approximately $38 billion and the solar panels another $6.5 billion.
We now have a “wall of opportunity” to pay for the treatment our citizens need without creating additional debt. Since this was a manmade epidemic created by big pharma, I think it is appropriate for the companies responsible to “sponsor” a 250-mile section of the wall as an act of goodwill, giving back to the communities they took from. I imagine it would be similar to The Tobacco Master Settlement Agreement (MSA) of 1998; however, every dollar generated from the wall would be pumped into the states that are currently self-funding treatment to clean up the mess created from the opioid epidemic.
A billion-dollar taskforce is a Band-Aid. America’s opioid epidemic continues to grow increasingly dire every day; affecting every socioeconomic sector in the United States. Every citizen must become aware of the drain on our resources if action is not taken to fund each state’s individual needs. There is no perfect plan that will “magically” undo a national disaster born from the myth of opioids being non-addictive, but a $44.5 billion wall is pennies compared to the crushing financial burden that has been thrust upon Americans from this crisis.
“A $44.5 billion wall is pennies compared to the crushing financial burden that has been thrust upon Americans from this crisis.”
I must make a disclaimer: I have been using drugs, buying drugs, investigating drugs, studying drugs for the past 32 years. I am a self-professed expert in all things drugs. 26 years with the DEA, combined with personal experience taking pain pills for a bad back gives me a perspective that is quite unique. Nothing in books or on TV can prepare one to deal with the devastating issues that surround drug addiction. TITAN’s mission is to educate not only doctors and pharmacists, but the other side as well, in hopes that together we can end the story of opioid addiction once and for all.